Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
Department of Engineering, University of Cambridge, Cambridge, UK.
J Bone Miner Res. 2022 Feb;37(2):256-264. doi: 10.1002/jbmr.4465. Epub 2021 Dec 16.
Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
罗莫索单抗单克隆抗体治疗通过与硬骨素结合而起作用，导致骨形成的快速刺激，同时减少骨吸收。罗莫索单抗引起的椎体骨增加的位置和局部幅度，以及它与特立帕肽的比较，仍有待研究。在这里，我们分析了一项研究的数据，该研究在罗莫索单抗（每月 210mg sc，n=17）、开放标签每日特立帕肽（20μg sc，n=19）或安慰剂（每月 sc，n=20）治疗后 12 个月收集腰椎计算机断层扫描（CT）脊柱扫描。对于每个 56 名女性，皮质厚度（Ct.Th）、内皮质厚度（Ec.Th）、皮质骨矿物质密度（Ct.bone mineral density（BMD））、松质骨矿物质密度（Cn.BMD）和皮质质量表面积密度（CMSD）均在第一腰椎表面进行测量。此外，还对腰椎结构变化的彩色图谱进行了统计分析，并在骨表面上进行了可视化。12 个月时，罗莫索单抗与安慰剂相比，所有参数均显著改善，导致椎体 Ct.Th 平均增加 10.3%，特立帕肽增加 4.3%，Ec.Th 增加 137.6%，特立帕肽增加 47.5%，Ct.BMD 增加 2.1%，特立帕肽减少 0.1%，CMSD 增加 12.4%，特立帕肽增加 3.8%。对于所有这些测量，罗莫索单抗与特立帕肽之间的差异均具有统计学意义（p<0.05）。罗莫索单抗与特立帕肽相关的 Cn.BMD 增加率分别为 22.2%和 18.1%，但均显著高于安慰剂组的变化（-4.6%，p<0.05）。皮质图谱显示了骨在椎体壳、壁和终板易骨折区域增加的地形位置。这项研究证实了罗莫索单抗或特立帕肽治疗后广泛的椎体骨增加，并提供了新的见解，即使用这些合成代谢剂如何快速预防骨质疏松症妇女的椎体骨折。© 2021 作者。骨与矿物研究杂志由 Wiley 期刊公司代表美国骨与矿物研究协会（ASBMR）出版。
